A practitioner's guide to emphasizing choice-making opportunities in behavioral services provided to individuals with intellectual and developmental disabilities.

Promoting choice is a defining value guiding Positive Behavior Support (PBS) models for serving individuals with intellectual and/or developmental disabilities (IDD). The ability to make independent choices is of paramount importance to self-advocacy and self-determination. Promoting choice is also an essential commitment of trauma-informed care (TIC) in the provision of services to vulnerable individuals, as trauma often involves experiences in which an individual has no control over aversive events that occur, and choice-making opportunities can empower traumatized individuals to regain control over the environments they routinely encounter. However, incorporating meaningful choice making into behavioral programming is often more difficult than it seems. We synthesize the relevant, contemporary literature to provide professionals with actionable suggestions for incorporating choice making into everyday behavioral services. After summarizing the importance of promoting choice into behavioral services based on the values that define both PBS and TIC frameworks, we (a) offer a behavior-analytic interpretation of the skill of making choices, (b) synthesize key literature on how to teach choice making skills, (c) provide recommendations for the situations within one's care in which choice-making opportunities may be most beneficial, and (d) discuss some of the barriers and potential solutions to incorporating choice-making opportunities for individuals with IDD.

Toward trauma-informed applications of behavior analysis.

Despite a growing acknowledgement of the importance of understanding the impacts of trauma on therapeutic approaches across human service disciplines, discussions of trauma have been relatively infrequent in the behavior analytic literature. In this paper, we delineate some of the barriers to discussing and investigating trauma in applied behavior analysis (ABA) and describe how the core commitments of trauma-informed care could be applied to behavior analysis. We then provide some examples of how trauma-informed care might be incorporated into ABA practice. We conclude by suggesting opportunities to approach trauma as a viable avenue for behavior analytic research and argue that omitting trauma-informed care from ABA could be detrimental not only to the public perception of ABA, but to the effectiveness of our assessment and treatment procedures.

Association of Childhood Maltreatment With Suicide Behaviors Among Young People: A Systematic Review and Meta-analysis.

Importance: Children and young people's reports of experiences of adverse childhood events have increased in recent years, and this trend has been associated with an elevated risk for suicide behaviors. However, a systematic review and meta-analysis is needed to confirm the significance of this association in young people. Objective: To quantify the association between core types of childhood maltreatment, including sexual, physical, and emotional abuse and/or neglect and suicide behaviors in children and young adults. Data Sources: Medline, PsychInfo, Embase, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health) databases were searched from January 1, 1980, until December 31, 2019. The reference lists of all the included studies were also checked. Study Selection: Quantitative studies that focused on the association between core types of childhood abuse and/or neglect and suicide ideation, plans, and attempts. Data Extraction and Synthesis: Data were extracted by 2 independent raters. Publication bias and risk of bias across studies were assessed. Meta-analyses using random-effect models were applied, and heterogeneity was quantified using the I2 statistic. Data were analyzed from January to May 2020 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guidelines. Main Outcomes and Measures: The association between core types of childhood maltreatment and suicide behaviors. Results: Seventy-nine studies with 337 185 young individuals (mean [SD] age, 15.67 [2.11] years; 63.19% female) were included. The findings demonstrated that sexual abuse (odds ratio [OR], 3.41; 95% CI, 2.90-4.00), physical abuse (OR, 2.18; 95% CI, 1.75-2.71), emotional abuse (OR, 2.21; 95% CI, 1.37-3.57), emotional neglect (OR, 1.93; 95% CI, 1.36-2.74), physical neglect (OR, 1.79; 95% CI, 1.27-2.53), and combined abuse (OR, 3.38; 95% CI, 2.09-5.47) were significantly associated with higher rates of suicide attempts. Core types of childhood maltreatment were also associated with as much as 2.5-fold greater odds for suicide ideation, and sexual abuse with a 4.0-fold increase for suicide plans. Studies based on community samples (ß [SE] = -1.68 [0.79]; P = .04) or with lower methodological quality (ß [SE] = -2.86 [1.30]; P = .03) were associated more strongly with suicide attempts in those reporting experiences of sexual abuse, whereas young age was associated with both suicide attempts (ß [SE] = -0.59 [0.27]; P = .03) and ideation (ß [SE] = -0.41 [0.18]; P = .03). Conclusions and Relevance: These findings suggest that policy actions should focus on raising public awareness and offering proactive suicide prevention therapies for children and young adults who have experienced abuse and/or neglect.

Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review.

In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18-81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18-27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86-3.86], physical abuse (OR 2.16, 95% CI 1.60-2.91), emotional abuse (OR 2.70, 95% CI 1.92-3.79), emotional neglect (OR 2.29, 95% CI 1.69-3.10), physical neglect (OR 1.57, 95% CI 1.27-1.94) and combined abuse (OR 3.09, 95% CI 2.14-4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.

The Good Behavior Game: A brief review.

The Good Behavior Game (GBG) is a group contingency that reduces disruption and increases engagement in various contexts. In recent years, researchers have extended the GBG in at least 3 ways: (a) demonstrating its efficacy with novel populations, settings, and behaviors, (b) examining procedural variations that improve contextual fit, and (c) using more comprehensive data collection methods to explore the behavior of individual students and indirect effects. The purpose of the current review is to summarize recent advances, discuss implications of recent studies and potential mechanisms for the general efficacy of the GBG, and suggest future directions.

Does the Good Behavior Game evoke negative peer pressure? Analyses in primary and secondary classrooms.

The Good Behavior Game (GBG) is a classroom management system that employs an interdependent group contingency, whereby students work as a team to win the game. Although previous anecdotal data have suggested that this arrangement may promote prosocial behavior, teachers may have concerns about its fairness and potential to evoke negative peer interactions (especially toward students who break the rules). We evaluated disruptive behaviors and social interactions during the GBG in a secondary classroom for students with emotional and behavioral disorders, as well as in a primary classroom for students with mild developmental disabilities. Results indicate that the GBG reduced disruptive behaviors; further, negative peer interactions decreased and positive interactions increased when the game was being played. Social validity results indicate that the majority of students thought the interdependent group contingency was fair.

Examining the effects of punishment schedule density on the development and maintenance of avoidance and safety behaviours: Implications for exposure therapies.

BACKGROUND AND OBJECTIVES: Engaging in safety behaviors in the absence of actual threat is a key feature of many psychological disorders, including OCD and depression. Failure to discriminate between threatening and safe environments may make these behaviors resistant to change. The purpose of the current study is to investigate the conditions under which avoidance and safety behaviors are developed and maintained. METHODS: In experiment 1, sixty-seven participants who were initially screened for low obsessive-compulsive behavior were invited to play a computerized game to gain points and avoid their potential loss. In Phase 1, they were exposed to a lean punishment schedule (relatively frequent point losses) and a dense schedule (highly frequent point losses). In Phase 2, they were tested on engagement in safety behaviors, where no punishment had been programmed. In experiment 2, twenty-two new participants were exposed to the lean punishment schedule followed immediately by the no point loss condition (Phase 2), one and two weeks after their initial exposure to the punishment conditions to test for the maintenance of safety behavior over time. RESULTS: Findings demonstrated that participants developed avoidance immediately, but safety behavior was developed and maintained only for those who were exposed to the lean punishment schedule. LIMITATIONS: Prolonged exposure to dense punishment schedules may yield different results because the contrast between safe and aversive environments may be less discernible. CONCLUSIONS: These findings are important because they provide experimental evidence on the conditions that render safety behaviors difficult to amend, and offer important recommendations for clinical practice.

The effects of the non-contingent presentation of safety signals on the elimination of safety behaviors: An experimental comparison between individuals with low and high obsessive-compulsive profiles.

BACKGROUND AND OBJECTIVES: Safety behaviors, defined as engagement in avoidance within safe environments, are a key symptom of obsessive-compulsive and related disorders. They may interfere with daily functioning and as such their emission should be reduced. The purpose of the current study is to investigate the effects of the non-contingent presentation of safety signals (cues produced by safety behaviors) on reducing safety behaviors in participants self-reporting low and high OCD profiles. METHODS: In total, 32 participants were asked to play a game to gain points and avoid their loss. After having developed avoidance behavior, evidenced by maintaining all of their earned points, they were exposed to safe environments where no point loss was programmed. In Test 1, safety cues (blue bar) were produced contingent on performing safety behaviors. In Test 2, safety cues were presented continuously without any response requirement. RESULTS: Findings demonstrated that high OCD group displayed higher rates of safety behaviors than low OCD group. However, exposure to the non-contingent presentation of safety signals eliminated their emission in both groups. LIMITATIONS: Future studies need to evaluate the effects of different non-contingent schedules on the suppression of safety behaviors. CONCLUSIONS: These findings contribute to the literature by demonstrating that non-contingent introduction of safety signals eliminated safety behaviors completely, even in high OCD participants, who performed safety behavior at higher rates. Such a treatment protocol may ameliorate exposure therapy in which response prevention constitutes a key element and is generally associated with increased drop-out rates.

An evaluation of interdependent and independent group contingencies during the good behavior game.

The Good Behavior Game (GBG) uses an interdependent group contingency to improve classroom behavior. Despite the wealth of research on the effectiveness of the GBG, some teachers may have concerns about their students' abilities to work in teams, particularly if they have a history of poor social skills. We used an alternating treatments design to compare the relative effectiveness of the GBG with interdependent and independent group contingencies in a classroom for children with emotional and behavioral disorders. Our results showed that both versions of the GBG reduced verbal disruptions, inappropriate sitting, and off-task behaviors for all children. However, the majority of children preferred the interdependent arrangement. We discuss how these results may promote more widespread use of the GBG with children with substantial behavioral challenges.

Maintenance of safety behaviors via response-produced stimuli.

Animal studies suggest that safety behaviors may be maintained by internally or externally produced safety signals, which function as positive reinforcers. We designed two experiments to test this phenomenon with humans. Participants played a computerized game in which they could earn or lose treasures by clicking on a map. In baseline, losses could be postponed by pressing a pedal that also produced a blue bar at the bottom of the screen. During test conditions, no losses were programmed, and pedal presses turned the bar from yellow to blue (Test 1) or blue to yellow (Test 2). In Experiment 2, new participants were exposed to the same conditions but were given information about the safety of the test environment. In both experiments, participants engaged in high rates of pedal pressing when presses were followed by blue bars, suggesting the bar functioned as a safety signal. We discuss how these findings may relate to safety behaviors commonly observed in certain mental health disorders.

Validating trial-based functional analyses in mainstream primary school classrooms.

There is growing evidence to support the use of trial-based functional analyses, particularly in classroom settings. However, there currently are no evaluations of this procedure with typically developing children. Furthermore, it is possible that refinements may be needed to adapt trial-based analyses to mainstream classrooms. This study was designed to expand the trial-based functional analysis literature by implementing the procedure in 2 mainstream primary school classrooms and validating the analysis through comparison of multiple treatment options, including some that were not indicated by the functional analysis. We also extended the procedure by including a peer-attention condition and obtaining data from teachers regarding the feasibility of the procedures. For all participants, functional analysis results helped to identify effective treatments. Furthermore, relative effects among treatments were accurately predicted by the functional analysis outcomes. Teachers reported that they understood the logic of functional analysis and found both analysis and treatment procedures to be easy and effective.

Validating the gambling functional assessment--revised in a United kingdom sample.

The gambling functional assessment-revised (GFA-R) was designed to assess whether the respondent's gambling was maintained by positive reinforcement or escape. The present study attempted to validate the GFA-R's psychometric properties using United Kingdom (UK) university students and to compare the results to those from a sample of American university students. Two hundred seventy four UK students completed the GFA-R, and 153 also completed the South Oaks gambling screen (SOGS). Two hundred one United States (US) university students completed both measures. A confirmatory factor analysis indicated that the original model of the GFA-R provided an excellent fit for the UK data and internal consistency was high. These outcomes were similar, if not superior, to those from the US sample. SOGS scores strongly correlated with GFA-R escape subscale scores in both samples, replicating previous results. These findings indicate that the GFA-R is a valid measure for use in the UK, which is potentially useful to both practitioners and researchers. They also suggest that the strong relationship between endorsing gambling as an escape and measures of disordered gambling may be ubiquitous.

Using differential reinforcement of low rates to reduce children's requests for teacher attention.

We evaluated the effectiveness of full-session differential reinforcement of low rates of behavior (DRL) on 3 primary school children's rates of requesting attention from their teacher. Using baseline rates of responding and teacher recommendations, we set a DRL schedule that was substantially lower than baseline yet still allowed the children access to teacher assistance. The DRL schedule was effective in reducing children's requests for assistance and approval, and the teacher found the intervention highly useful and acceptable. The possible mechanisms that account for behavior change using full-session DRL schedules are discussed.

Fixed-time teacher attention to decrease off-task behaviors of typically developing third graders.

Evidence to validate the use of fixed-time (FT) reinforcer delivery (i.e., noncontingent reinforcement) with typically developing populations has been relatively rare in the behavioral literature. In those studies that have provided validation, reinforcer delivery schedules appeared to be prohibitively dense for sustained implementation of procedures. This study demonstrated the efficacy of using FT reinforcer delivery to reduce off-task behavior of 2 typically developing third graders using a teacher-selected schedule (FT 4 min). Immediate reductions in off-task behavior were observed for both children. Challenges in identifying the operative mechanism of FT schedules in natural settings are discussed.